水化和他汀类药物预防对比剂肾病的临床观察

目的探讨他汀类药物在预防对比剂肾病(contras-t induced nephropathy,CIN)中的作用。方法选择行经皮冠状动脉造影病人115例,采用随机数字表法将病人分为他汀组(n=40)、水化组(n=34)以及对照组(n=41)。他汀组于冠状动脉造影术前3d开始每晚顿服阿托伐他汀20mg,水化组予0.9%氯化钠注射液静脉滴注,速度为1ml/(kg.h),一般于术前4h开始至术后12h结束,对照组未服用阿托伐他汀及其他调脂类药物亦未应用水化处理。观察患者术前1d、术后36～48h血清肌酐(Scr)、内生肌酐清除率(Ccr)、尿白蛋白肌酐比(UACR)以及超敏C反应蛋白(hsCRP)的改变情况。结果他汀组及对照组两组患者术后血hsCRP、Scr,UACR较术前均升高(均P<0.05),而血Ccr较术前降低(P<0.05)。对照组患者术后血hsCRP、UACR较他汀组术后明显升高(P<0.05),对照组对比剂肾病发生率(9.76%)高于他汀组(5.00%)。水化组术后血hsCRP、Scr、UACR及血Ccr与术前相比差异无统计学意义,对比剂肾病发生率明显小于他汀组及对照组。结论造影剂可造成轻微的肾功能损害;术前3d使用他汀药物,可能具有减轻炎症反应、预防造影剂肾病发生的作用,但相比之下水化处理更能明显减少对比剂肾病的发生。

Clinical Research on efficacy of Hydration and Statins in Preventing Contrast-induced Nephropathy

Objective To investigate the efficacy of hydration and statins in preventing contrast-induced nephropathy（ CIN）. Methods 115 patients who undergoing coronary angiography were randomly divided into three groups： atorvastatin group （n = dO）, hydration group（n = 34） and control group（n = 41）. Patients in atolwastatin group were given atorvastatin 20 mg/d 3 days before coronary angiography, hydration group received 0.9% saline infusion,, speed is lrnl/kg/h, generally in the preoperative 4h to postoperative 12h end, the control group did not take atorvastatin and other regulating lipid medicine nor the application of hydration. Serum levels of urea, creatinine, hsCRP and Urine albumin/creatinine （UACR） before and after the procedure were compared among the groups. Endogenous creatinine clearance rate was calculated. Results （1） In the control group and atorvastatin-treated group, compared with the value before coronary angiography, UACR, Scr and hsCRP significantly increased from 36 to 48 hours after angiography（ P 〈 0. 05）. Ccr significantly decreased from 36 to 48 hours after angiography（ P 〈 0.05）. （2） Compared with the atorvastatin-treated group, the values of hsCRP, UACR significantly increased at the 2nd day after angiography in the control group（ P 〈 0.05）, incidence of contrast induced nephropathy（CIN） significantly increased too（9.76% vs 5.00% ）. （3） UACR, Scr, hsCRP and Ccr had no diversity after angiography in the hydration group, incidence of CIN significantly decreased（0% ）. Conclusions Contrast media induces light renal function damage. Pretreatment with atorvastatin 20mg/qn for 3 days could significantly reduce procedural inflammatory reaction and prevent contrast-induced nephropathy. Hydration can significantly reduce the incidence of contrast-induced nephropathy.